Coexistent Mental Health Disorders in Diabetic Patients

As the world celebrates the world diabetes day today the 14^th November 2018 it is important to note that persons living with diabetes  may be particularly vulnerable to developing mental health disorders because diabetes is considered one of the most psychologically and behaviorally demanding chronic medical conditions. Studies have shown that diabetes is more prevalent in psychiatric patients than in the general population. Depression, anxiety and schizophrenia are just a few of the mental health co morbidities seen amongst persons living with diabetes. Co morbid psychiatric illness has further been linked to worse health outcomes in diabetic patients.

Co morbid Mental Health Disorders

Even nonclinical levels of depressive symptoms and minor depression have been associated with problems with adherence, risk of complications, functional impairment, higher medical costs, and death.  Increased severity of depressive symptoms has been connected to a greater probability of emergency department, primary care, specialty care, medical inpatient, and mental health costs. Depressive symptoms have been found to be more persistent in amongst persons living with diabetes compared with those without the disease. Fear of diabetes complications can lead to anxiety in persons with diabetes. Anxiety and depression were linked to more perceived symptoms of diabetes, longer anticipated duration of illness, more serious diabetes complications, worse diabetes control, greater healthcare use and costs, decreased medication adherence, and higher mortality rates.

Importance of Integrated Care

Strategies to improve the detection and treatment of mental health disorders in persons living  with diabetes are critical in order to improve function and decrease disability. Evidence from several controlled trials suggests that the detection and treatment of depression improves glycemic control. However, depression and anxiety are under detected and under treated in diabetic patients; these conditions are recognized in <50% of diabetic patients who have them. Diabetic patients should be regularly screened for symptoms of anxiety and depression since they are at higher risk for these conditions.

Reference

Thomas., LT. (2015) Co existent mental health disorders in diabetic patients. US Pharmacist, 40(11):37-42

For further reading https://www.uspharmacist.com/article/coexistent-mental-health-disorders-in-diabetic-patients

Part two; Natural remedies for treating bipolar disorder

a.      Managing a manic episode

It is not always possible to prevent a manic episode, but as the condition progresses, the individual and their friends and family may start to notice the signs of a mood change. Here are some tips when this happens:

-          See a doctor, if it is the first time, if you have discontinued treatment, or if treatment is not working.

-          Follow the treatment plan and keep all medical appointments, as medications may need adjusting.

-          Try to keep to a regular sleeping pattern and avoid unnecessary stress when possible.

-          Eat a healthful diet and get enough exercise.

-          Avoid alcohol and other substances.

-          Keep track of your moods and feelings.

-          If you have people around you, try to share with them what is happening so that they can support you.

b.      Alternative remedies

Other remedies that do not involve the use of traditional drugs include supplements and counseling. Such include;

i.                    Omega-3

Salmon contains omega-3 oil. The fish oil extract omega-3 may help, according to some studies. Scientists have found that bipolar disorder is less common in countries where people consume a lot of fish. People with depression may also have lower levels of omega-3 in their blood.Omega-3 fatty acids may have numerous health benefits, but it is best to eat them in their natural form. Cold-water fish, nuts, and plant oils are good sources.

ii.                  Magnesium

Some scientists think magnesium has a role regulating mood and both manic and depressive episodes and work with the medications to make them work effectively. As a result, some doctors may recommend magnesium supplements. Taking a multivitamin will include the daily recommended dosage of magnesium.

iii.                Vitamins

Some people suggest that vitamins may help, specifically vitamin C and folic acid. Researchers have found weak evidence that vitamin C may help, but none to support the use of folic acid specifically for bipolar disorder. There is evidence that folic acid supports cognitive health, but it is not clear whether this or other vitamins can help with bipolar disorder. Overall, it is not clear that dietary supplements can help people with bipolar disorder. More studies are needed to confirm the benefits of any supplement.

iv.                Nutrients in the diet

However, a diet that provides a variety of nutrients through fresh foods can help protect a person from a range of health problems. Green leafy vegetables are high in folic acid, and citrus fruits are a great source of vitamin C. Anyone with bipolar disorder who decides to use complementary medicine should continue with their prescribed medication therapy sessions, and they should consult their physician before using supplements or an alternative therapy.

c.       Counseling and CBT

Research shows that CBT can help people to manage the challenges of bipolar disorder. Counseling, for example, cognitive behavioral therapy (CBT) appears to be helpful in managing the symptoms of bipolar disorder. A meta-analysis published in 2017 concluded that "CBT is effective in decreasing the relapse rate and improving depressive symptoms, mania severity, and psychosocial functioning." The studies reviewed showed that the effects of CBT were "mild to moderate," and the improvements were most significant if a person attended sessions of 90 minutes or longer. CBT can help people to identify negative and destructive habits and behaviors, and to change them to more positive ones.

d.      Clinical support and treatment

A psychiatrist who specializes in bipolar disorder will normally guide a person's treatment.

Sometimes there may be a wider team of professionals, including a social worker and a counselor.

e.       Medications

Various medications are available to treat the disorder. Doctors do not usually prescribe antidepressants alone for a person with bipolar disorder, even during a low mood, because they can trigger a manic episode. For this reason, the person will normally use an antidepressant with a mood stabilizer or antipsychotic. A doctor may recommend hospitalization if a patient is experiencing psychosis or if their symptoms may pose a danger to themselves or other people.

Article courtesy of Medical News Today

Part one; Natural remedies for treating bipolar disorder

A person with bipolar disorder experiences times of severe depression and times of mania, or "high" mood. The risks during a low mood include an inability to function at work and in other areas of life. During mania, the person may be at risk of making reckless decisions. If the mood becomes too high or low, psychosis can develop. There is no cure for bipolar disorder, but treatment enables people to manage it. Some of the following lifestyle adaptations can also help, alongside the medication:

a.      Lifestyle changes

Counseling, cognitive behavioral therapy (CBT), and a range of lifestyle changes can help people with bipolar disorder to manage their symptoms and improve their overall quality of life.

b.      Sleep

Regular sleep is important for people with bipolar disorder. Bipolar disorder can disrupt a person's sleep. During a manic phase, an individual may sleep very little, but during a low phase, they may sleep for a long time. Missing sleep can trigger a mood change, and getting enough sleep is essential to managing mood. Good sleep hygiene can encourage people with the condition to have regular sleep. Tips include:

-        going to bed and getting up at regular hours

-        making sure the room is comfortable

-        avoiding screen time and potentially stressful situations before bed

-        not eating a large meal too soon to sleeping

-        avoiding or limiting alcohol intake

-        People with bipolar disorder who have difficulty sleeping should speak to their physician.

c.       Diet

A healthful diet is an important lifestyle habit for a person with bipolar disorder. A 2011 study found that up to 68 percent of people seeking treatment for bipolar disorder have excess weight or obesity. People with bipolar disorder also had a higher risk of various other conditions, including diabetes, low bone density, and cardiovascular disease. A healthful diet can help to reduce the risk of these conditions. In 2013, another study found that people with bipolar disorder are more likely to engage in binge eating than the general population. This may be a side effect of medication or due to overeating during episodes of depression. Being overweight can complicate recovery and increase the risk of diabetes, high blood pressure, and anxiety. Regular eating habits can help people with bipolar disorder to stay healthy and avoid gaining excess weight.

Doctors do not know what causes bipolar disorder, but it may be due to an imbalance of chemicals in the brain. These chemicals, also called neurotransmitters, are noradrenaline, dopamine, and serotonin. Serotonin can also affect appetite. It may be that when serotonin levels are low, people experience cravings for carbohydrates and sweet foods. Tips for maintaining a healthful diet include:

-          keeping to regular eating times

-          ensuring that the diet is varied, well-balanced, and has plenty of fresh fruits and vegetables

-          making a meal plan for the week, preparing a list before going to the grocery store, and sticking to it

-          Learning and practicing new recipes during times of positive mood may help a person to establish these habits.

d.      Exercise

Moderate and regular exercise can help to balance mood and prevent a number of health problems, such as obesity and cardiovascular disease. There is a lack of evidence to show that physical activity can specifically help people with bipolar disorder, but some research suggests it may help to improve mood during a low phase. A 2015 review of studies suggested that exercise "may be a viable and effective strategy to deal with the depressive phase of bipolar disorder." Another review, published in 2016, concluded that "generally, exercise was associated with improved health measures, including depressive symptoms, functioning, and quality of life." More studies are needed to find out how much exercise an individual should have, how often, and how intense the activity should be, especially as bipolar disorder involves a number of physical and psychological factors.

 e.       Practicing moderation

People with bipolar disorder have a higher risk of engaging in addictive behaviors. One study found that 56 percent of people with the condition had at some time experienced addiction involving either alcohol or drugs. Certain circuits in the brain play a role in pursuing rewarding experiences. One study has suggested that people with bipolar disorder have stronger activation in these circuits. This may be what drives the person towards risky behavior. The positive side of this, say the authors of the study, is that it encourages people to work with energy toward their goals and ambitions. On the other hand, it may mean that an individual focuses fully on the short-term rewards of a decision while disregarding the possible long-term risks. Tips for avoiding these problems include:

-          becoming more aware of any tendency to engage in risky — for example, addictive — behaviors

-          seeking help if there is already a problem

-          asking friends and loved ones to support any decisions to avoid destructive or addictive behaviors

-          Friends who are aware of the risks might, for example, suggest going to see a movie instead of a bar on a night out.

Article courtesy of Medical News today

Stand up for your health

Structured workouts are essential for optimal health. But you should also try to stand and move around more during the day, especially if you have a desk job. Sitting for hours on end can increase your risk of serious ailments such as heart disease, type 2 diabetes, and certain cancers. By contrast, you can lower your risks of all of these conditions simply by standing and moving more — even if you already exercise. That's because routine movement during the day adds on to those benefits.

That was the conclusion of a large, long-term study of 123,000 middle-aged adults by researchers from the American Cancer Society, published in the American Journal of Epidemiology. Women who sat the most had a 34% greater risk of dying from any cause over the 14 years of the study compared with those who sat the least. For men, the increase was 17%. When exercise was factored in, the difference was even starker. The most sedentary women, who neither moved nor exercised a lot, were almost twice as likely to die during the study period as those who moved and exercised the most. The most sedentary men were 50% more likely to die than their more active counterparts. Similarly, other studies have concluded that routine, everyday movement has benefits, whether for heart disease, diabetes, cancer, or weight loss. It's gotten to the point now where some doctors actually advise their patients to use sitting "in moderation."

Why does prolonged sitting have such harmful health consequences? One explanation is that it relaxes your largest muscles. When muscles relax, they take up very little sugar (glucose) from the blood, raising your risk of type 2 diabetes. In addition, the enzymes that break down blood fats (triglycerides) plummet, causing levels of the "good" cholesterol, HDL, to fall, too. The result is a higher risk of heart disease.

By contrast, everyday movement not only reduces your risk of major ailments, but also helps you burn more calories. Dr. James Levine at the Mayo Clinic coined the term "non-exercise activity thermogenesis," or NEAT, to refer to the energy you burn through ordinary activity that you don't think of as exercise, such as fidgeting, carrying the laundry upstairs, dancing around the house to your favorite tune, or even standing while you talk on the phone. In one study, he measured NEAT in lean and obese people, all of whom had similar jobs and were forbidden to exercise during the course of the study. There was one key difference between the two groups. The obese people sat more than their lean counterparts, by an average of two-and-a-half hours more per day. Changing that behavior could result in burning up to 350 more calories a day.

Article courtesy of Harvard Health Publications